Asymptomatic polymethylmethacrylate (PMMA) in right atrium and right ventricle

Objective

Central venous migration of polymethylmethacrylate (PMMA) is a rare but potentially serious complication of percutaneous injection of PMMA performed to treat symptomatic vertebral fractures.

Most emboli cases to the heart result in cardiac perforation but the management of asymptomatic cases is unknown. Here we describe a rare case of a patient with asymptomatic intracardiac PMMA involving the right atrium and right ventricle, managed with observation over 6 years.

Methods

A 69 year old female treated with PMMA for osteoporosis related vertebral fracture, who developed sudden onset of transient dyspnea in the immediate postprocedure period. She was noted to have a PMMA material in the right atrium and ventricle on imaging. We will review the literature on management cardiac emboli.

Results

Our case is one of the first case report of asymptomatic cardiac emboli managed with observation and without anticoagulation.

Conclusion

This case discusses the rare occurrence of asymptomatic PMMA material found in the cardiac chambers, followed for 6 years. It also highlights that dyspnea in the perioperative period should be investigated further.